Groin Pain: Causes and When to Worry

Where groin pain comes from

The groin contains many structures in a small space: the adductor muscles of the inner thigh, the lower abdominal wall and inguinal canal, the hip joint (which is felt in the groin, not the side of the hip), lymph nodes, blood vessels, nerves, and in men the spermatic cord to the testicles. Pain can also be referred from the kidneys, ureter, lower back and pelvic organs.

Common causes of groin pain

Groin strain (adductor strain)

A muscle strain of the inner thigh, often called a pulled groin, is the most common cause in active people. It happens with sudden changes of direction, kicking, sprinting and skating.

• sudden pain high on the inner thigh during sport
• pain when squeezing the knees together or lifting the leg sideways
• tenderness and sometimes bruising

Mild strains recover in 1 to 3 weeks; severe ones can take 6 to 12 weeks.

Inguinal hernia

An inguinal hernia is tissue pushing through a weak spot in the lower belly wall. It causes:

• a bulge that is bigger when you stand, cough or strain and shrinks when you lie down
• an aching or dragging feeling, worse at the end of the day
• in men, sometimes a swelling into the scrotum

It is far more common in men. A femoral hernia, lower in the groin crease, is more common in women and more likely to get stuck.

Hip joint problems

The hip joint lies deep in the groin, so hip problems show up as groin pain, often wrapping around the hip in a "C" shape.

• Osteoarthritis: groin and thigh ache, morning stiffness, difficulty putting on socks; over 50.
• Femoroacetabular impingement and hip labral tear: sharp groin pain with deep bending, twisting or sitting, often with clicking or locking; young adults and athletes.
• Avascular necrosis: deep groin pain from loss of blood supply to the hip bone; linked to steroids and heavy alcohol use.
• Stress fracture of the femoral neck: groin pain that worsens with running, in endurance athletes and military recruits.

Athletic pubalgia (sports hernia) and osteitis pubis

Athletes in twisting and kicking sports can strain the attachments of the abdominal and adductor muscles at the pubic bone. Pain is felt in the lower belly and groin during exertion and on coughing or sit-ups, without a visible bulge.

Groin pain in men

• Testicular torsion: sudden, severe testicle pain spreading to the groin, often in teenagers. An emergency.
• Epididymitis: gradual pain and swelling at the back of the testicle, often with urinary symptoms.
• Varicocele: a dull ache with a "bag of worms" feeling above the testicle.
• Prostatitis: pain between the scrotum and anus, in the groin and on urination.
• Inguinal hernia: more common in men.

Groin pain in women

• Ovarian cysts or ovarian torsion: one-sided pelvic and groin pain; torsion is sudden and severe.
• Ectopic pregnancy: one-sided pain and bleeding in early pregnancy.
• Round ligament pain: brief, sharp groin pain in pregnancy when moving or turning.
• Pelvic girdle pain: pain at the front of the pelvis and groin during pregnancy.
• Femoral hernia: a small lump below the groin crease.
• Pelvic inflammatory disease and endometriosis: pelvic pain that can spread to the groin.

Other causes

• Kidney stones: waves of severe pain from the side or back moving to the groin.
• Swollen lymph nodes: tender lumps from infection in the leg, foot or genitals.
• Nerve entrapment: burning or tingling in the groin or upper thigh, sometimes after hernia surgery.
• Lower back problems: a pinched nerve root in the upper lumbar spine.
• Children: irritable hip, Perthes disease and slipped capital femoral epiphysis cause a limp with groin or knee pain.

How doctors find the cause

A doctor will ask how the pain started, what movements trigger it, and about urinary, bowel, testicle or menstrual symptoms. They examine the abdomen, groin and hernia sites (asking you to cough), the hip's range of motion, and in men the testicles.

Tests depend on the clues: urine tests, ultrasound for hernias, testicles or ovaries, X-ray of the hip and pelvis, MRI for labral tears, stress fractures and pubalgia, and CT for kidney stones.

Treatment and relief

For a groin strain

• Rest from aggravating activities for a few days, but keep gently moving.
• Apply ice for 15 to 20 minutes several times a day for the first 48 hours, then heat.
• Use acetaminophen (paracetamol) or ibuprofen as needed, following the label dose.
• Begin gentle stretches and adductor strengthening (such as squeezing a ball between the knees) as pain allows.
• Return to sport only when you can run, change direction and kick without pain.

Other treatments

• Hernias: surgical repair, especially if painful or growing.
• Hip problems: physical therapy, activity changes, injections, arthroscopy for labral tears or impingement, and hip replacement for advanced arthritis.
• Kidney stones: pain relief, fluids, and procedures for large stones.
• Testicular torsion: emergency surgery.

Frequently asked questions

When should I worry about groin pain?

Seek emergency care for sudden severe testicle pain, a painful groin bulge that will not go back in, inability to walk after a fall, or groin pain with fever and vomiting. See a doctor for groin pain that lasts more than 2 to 3 weeks or comes with a lump.

What causes groin pain in men?

The most common causes are groin muscle strains and inguinal hernias. Hip problems, kidney stones, epididymitis and prostatitis are also common. Testicular torsion causes sudden, severe pain and is an emergency, especially in teenagers and young men.

What causes groin pain in women?

In women, groin pain often comes from muscle strains, hip problems, ovarian cysts, pregnancy-related ligament or pelvic girdle pain, femoral hernias, urinary infections or kidney stones. Sudden, severe one-sided pain with nausea or bleeding needs urgent assessment for ovarian torsion or ectopic pregnancy.

Why does my groin hurt when I walk?

Groin pain when walking often comes from the hip joint (arthritis, a labral tear or a stress fracture), a groin strain, or a hernia. Pain that also stiffens the hip and limits putting on shoes points to arthritis. Pain that worsens over weeks of running suggests a stress fracture.

How long does a groin strain take to heal?

Mild groin strains usually improve within 1 to 3 weeks. Moderate strains take 4 to 6 weeks, and severe tears can take 3 months. Gradual strengthening helps prevent re-injury. Returning to sport too early is the most common reason strains recur.